Variation in outpatient consultant physician fees in Australia by specialty and state and territory

March 6, 2017

Med J Aust 2017; 206 (4): 176-180.

doi:10.5694/mja16.00653

Authors: Gary L Freed, Amy R Allen

The known Concerns have been expressed about high consultation fees and the potential for a two-tiered health system developing in Australia. Insurers are prohibited from covering outpatient physician consultation charges.

The new There were wide variations in bulk-billing rates and fees within specialties, between specialties, and between states and territories. Out-of-pocket payments by patients varied more than fivefold in some specialties.

The implications There is a lack of transparency and public availability of information about charges for outpatient consultations. Without data on quality of care, the justifiability of the differences in fees cannot be determined.

About 2.4 million initial consultations with consultant physicians are conducted in Australia each year.1 The Medicare program provides a set payment (rebate) for specific clinically relevant services to offset the cost to patients of private consultations.2 This payment is based on the “schedule fee”, the amount determined by the Department of Health as being reasonable, on average, for the service provided.2 The schedule fee for each eligible…